IMPLEMENTATION OF WHOLE BODY COOLING

Implementation of Whole Body Cooling



Implementation of Whole Body Cooling

Introduction

Many Level III NICUS are establishing whole body cooling (WBC) as a standard treatment for hypoxic-ischemic encephalopathy (HIE) (Reynolds & Talmage, 2011). It is estimated that 50 percent of neonates with severe HIE die, and the survivors are left with minor to serious complications (Cooper, 2011). However, the occurrence of HIE is not that common; HIE occurs in 1 to 2 1000 term infants with estimated 20% mortality and 25% neurodevelopment impairment (Zanelli et al., 2008). In the past only supportive care was offered to correct organ dysfunctions such as hypotension, hypoventilation, and electrolyte imbalances and treating seizures . Unlike WBC none of the previous supportive treatments focused on neurologic injury and resulted in infants with HIE having poor outcomes (Fairchild et al., 2010).

Hypothermia therapy is still a relatively new medical procedure but the therapy is gaining wide acceptance as the gold standard of care for infants with HIE (Reynolds & Talmage, 2011). Hypothermia therapy such as WBC is thought to play a neuroprotective role by decreasing the brains metabolic rate, decreasing production of nitric oxide (NO) and reducing free radicals (Cooper, 2011). Regardless of method of treatment for HIE, timely detection of signs and symptoms in infants who have experience a hypoxic event is crucial to the outcomes. Randomized trials have indicated that cooling should be initiated within first six hours after the insult to achieve better outcomes (Reynolds & Talmage, 2011). After the needs assessment was completed in March 2011 several objectives were establish concerning the initiation of whole body cooling. The first objective that was established from the need assessment was creating protocols which would include inclusion criteria, exclusion criteria, nursing protocols and order sets. The second objective was the education of staff on the pathophisiology and mechanism of action of hypothermia therapy. The final objective that evolved from the needs assessment was to create a formal education sheet for parents of infants with HIE. The purpose of this project was to implement and evaluate the process of introducing whole by cooling in a Level III neonatal intensive care unit. This paper will include the process of creating protocols/order sets, educating staff and preparing an information sheet for parents whose infant is receiving the intervention of whole body cooling. In addition, an evaluation of the implementation process and future plans for the actual start date of whole body cooling (WBC) will be discussed.

Objectives

To determine the effect of therapeutic hypothermia on death and long-term neurodevelopmental disability, and to ascertain clinically important side effects in newborn infants with HIE.

Secondary objectives include assessment of the adverse effects of cooling and effects on early prognostic indicators of adverse outcome. Subgroup analyses were planned on the basis of:1. Severity of HIE (mild, moderate, severe) (Sarnat 1976; Finer 1981)2. Inclusion criteria:a) Preterm (< 35 weeks gestation) vs. term or near-term (> 35 weeks gestation)b) Electrophysiological plus clinical criteria vs. clinical criteria ...